Brain Abscess

Question 1

 what are the predisposing factors of brain abscess

Answer 1

1. Direct spread through sinus or skull fracture or infection in the sinuses or middle ear etc.
2. Haematogenous spread from any side of primary infection mostly chest, heart, bone or dental abscess. 

Question 2

What is the most common group of bacteria that causes brain abscess

Answer 2

Streptococcus species

Question 3

What Bacteria’s may cause brain abscess

Answer 3

1. Streptococcus
2. bacteriodes
3. enterobacteria
4. staphylococcus

Question 4

What is a brain abscess

Answer 4

A collection of pus or infected material within the brain parenchyma. Usually through spread of infection from the body to the brain

Question 5

What are the symptoms of brain abscess

Answer 5

1. Headache, drowsiness and confusion
2. fever
3. focal neurological defects Such as hemiplegia
4. raised ICP
5. seizures
6. CN 3 and CN 6 palsy 

Question 6

What are the investigations carried out for brain abscess

Answer 6

1. CT scan brain
2. MRI brain
3. examination of abscess fluid by Gram stain or culture
4. blood CBC/ESR

Question 7

What is a characteristic finding of brain abscess in CT scan brain

Answer 7

Single or multiple low density areas that are peripherally enhanced. Ring appearance with central low density and surrounding cerebral oedema

Question 8

Why is lumbar puncture contraindicated in brain abscess

Answer 8

Raised ICP. May cause brain herniation. CSF finding is not helpful

Question 9

What does blood CBC/ESR show in brain abscess

Answer 9

1. Leucocytosis
2. raised ESR

Question 10

In HIV patients 90% of brain lesions are what

Answer 10

1. Lymphoma
2. toxoplasmosis

Question 11

What is the best investigation for brain access

Answer 11

Brain CT scan

Question 12

What is the treatment for patients with HIV suffering from cerebral toxoplasmolysis

Answer 12

1. Pyrimethamine
2. Sulfadiazine

Question 13

What is the Treatment for brain abscess

Answer 13

1. Medical
2. surgical

Question 14

What is the initial empirical antibiotic treatment for brain abscess

Answer 14

1. Ceftriaxone 2 g IV 12 hourly
2. Vancomycin 1 g 12 hourly
3. metronidazole 15 mg /KG (loading dose) followed by 7.5 mg /KG IV six hourly

Question 15

What is the specific treatment for brain abscess medical

Answer 15

Depends on the species being treated
1. Penicillin for streptococci
2. metronidazole for anaerobes
3. ceftazidime for gram-negative bacilli

Question 16

What is the surgical management of brain abscess

Answer 16

Stereotactic aspiration or surgical excision

Question 17

Patient with increased intracranial pressure may benefit by providing what other type of medication

Answer 17

Steroids such as dexamethasone 10 mg IV once, then 4 mg IV six hourly for three or four days.